Total of 21% had regional failure (16% in CRT arm, 25% in XRT alone arm)

Surgical salvage was achieved in 41% and 46% of the groups, so after surgery, LR control was approximately 90% in each group (p=NS)

In patients with nodal size >6 cm, relapse free survival was 84% in the CRT group compared to 64% in the XRT alone group (p=.10)

There was no difference in the development of distant metastases between groups

5 year DSS was 66% and 68% in the two groups

Author's Conclusions

Induction chemotherapy has a high response rate, but does not enhance long term regional nodal control, does not reduce distant metastases, or improve survival

Induction chemotherapy is not recommended as routine treatment for nasopharyngeal carcinoma

Clinical/Scientific Implications Compared to other head and neck cancers, the development of regional (nodal) and metastatic disease in nasopharyngeal cancer is much more common, and hence, presents a major dificulty in treatment. This study has a very long followup of up to 8 years, and therefore is valuable in assessing the impact of induction chemotherapy on the development of nodal and distant metastatic disease, and their impact on survival. This study confirms that induction chemotherapy followed by radiation therapy is not efficacious in the treatment of nasopharyngeal carcinoma. Concurrent chemoradiation, as outlined by Al-Sarraf, remains the standard of care in nasopharyngeal carcinoma